One of the largest obstacles to the transition to government-run, universal healthcare in the United States is the huge proportion of the economy- and the labor market (read: jobs)- dependent upon the existing health insurance industry. It’s one thing to say you want single-payer healthcare but it’s another to find solutions for the millions of peoples who's lives would be affected with the effective dissolution of the health care industry. Sure, costs may go down when the government is paying, but part of these high costs go into paychecks for insurance industry workers.

Legislators in California are working on a bill for single-payer healthcare in the state and while much of the discussion features the gigantic cost- ~$400 Billion annually- the real question that must be answered is what is going to happen to the employees of the gigantic health insurance companies that would be all but cut out of the picture should single-payer become the law of the land. One such company that provides both insurance coverage and healthcare itself, is the largest private employer in the state- what’s going to happen to the 160,000 workers it employs?

Problem
Healthcare in America may be a giant, convoluted mess but millions of Americans depend upon it for their employment and thus survival. Streamlining the process by implementing single-payer healthcare would lower costs for consumers but, in cutting out insurance companies, would jeopardize the futures of the hundreds of thousands of Americans employed in the health insurance industry. So far, proposals for single-payer have failed to present adequate solutions for those workers.

Solution
As the US continues to look to make the transition to a single-payer system, lawmakers should consider co-implementation with a basic income guarantee. Such a large transition in the economy will be majorly disruptive and everyone should be offered a guaranteed income until they find an alternative occupation. The Living Income Guaranteed scheme presented by the Equal Life Foundation is a good framework for making something this massive work.

Reward
Despite employing hundreds of thousands of people, as most other advanced countries have shown, the health insurance industry is largely redundant, making health care unnecessarily expensive. Transitioning to single-payer is a solution but it needs to be coupled with a basic income guarantee that supports those workers as the economy recovers from such a large change. Under such a program, everyone would be guaranteed an income sufficient to cover their basic needs as they search for alternative ways to earn a living.